Mini access guide to simplify calyceal access during percutaneous nephrolithotomy: A novel device.

Area of Science:

• Urology
• Medical Devices
• Surgical Techniques

Background:

• Accurate renal collecting system puncture is critical for percutaneous nephrolithotomy (PCNL).
• Existing techniques include bull's eye, triangulation, free-hand, and gradual descensus.
• A novel puncture guide is introduced to enhance accuracy in the bull's eye technique.

Purpose of the Study:

• To evaluate the efficacy of a novel mini access guide (MAG) in percutaneous nephrolithotomy (PCNL) access.
• To compare the MAG-guided technique with the traditional free-hand bull's eye technique.
• To assess the impact on fluoroscopy time and learning curve for novice surgeons.

Main Methods:

• The mini access guide (MAG) stabilizes the puncture needle using an adjustable carrier.
• Sixty patients with solitary renal calculus were randomized to traditional or MAG-guided bull's eye puncture.
• Fluoroscopy time and time to puncture were primary outcome measures.

Main Results:

• MAG-guided puncture significantly reduced median fluoroscopy time (21s vs. 55s, P=0.001).
• Median time to puncture was also reduced with MAG (55s vs. 80s, P=0.052).
• Novice residents demonstrated faster learning of the puncture technique using MAG on a simulator.

Conclusions:

• The MAG is a simple, portable, and cost-effective tool for PCNL access.
• It facilitates successful puncture and is particularly beneficial for novice urologists.
• The MAG contributes to a significant reduction in radiation exposure during PCNL access.